Desirudin

Desirudin is a prescription medication used to prevent blood clots during hip replacement surgery. Desirudin belongs to a group of drugs called direct thrombin inhibitors. These work by blocking a substance made in the body that helps to form blood clots.

This medication is available in an injectable form to be given directly under the skin (subcutaneously) by a healthcare provider.

Common side effects of desirudin include bleeding, injection site irritation, anemia, and nausea.

Desirudin is a prescription medication used to prevent blood clots during hip replacement surgery.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Desirudin may be found in some form under the following brand names:

• Iprivask

Serious side effects have been reported with desirudin. See the "Drug Precautions" section.

Common side effects of desirudin include the following:

• anemia (blood does not carry enough oxygen to the rest of the body)
• nausea
• bleeding
• injection site irritation

This is not a complete list of desirudin side effects. Ask your doctor or pharmacist for more information.

Tell your doctor if you have any side effect that bothers you or that does not go away.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• anticoagulant (blood thinner) medications such as warfarin (Coumadin, Jantoven), heparin, enoxaparin (Lovenox), fondaparinux (Arixtra), rivaroxaban (Xarelto), and apixaban (Eliquis)
• antiplatelets (a type of blood thinner)  such as clopidogrel (Plavix), aspirin, prasugrel (Effient), ticagrelor (Brilinta), ticlopidine (Ticlid), abciximab (ReoPro), eptifibatide (Integrilin), tirofiban (Aggrastat), dipyridamole (Persantine), and cilostazol (Pletal)
• selective serotonin reuptake inhibitors such as escitalopram (Lexapro), paroxetine (Paxil), and fluoxetine (Prozac)
• aspirin and other NSAIDs (nonsteroidal anti-inflammatory drugs) such as:
  • celecoxib (Celebrex)
  • diclofenac (Cambia, Cataflam, Flector, Voltaren, Zipsor and others)
  • etodolac (Lodine)
  • ibuprofen (Advil, Motrin, Nuprin)
  • indomethacin (Indocin, Indocin SR)
  • ketoprofen (Orudis, Actron, Oruvail)
  • ketorolac (Toradol)
  • meloxicam (Mobic)
  • nabumetone (Relafen)
  • naproxen (Naprosyn)
  • naproxen sodium (Aleve, Anaprox, Naprelan)
  • oxaprozin (Daypro)
  • piroxicam (Feldene)

This is not a complete list of desirudin drug interactions. Ask your doctor or pharmacist for more information.

Serious side effects have been reported with desirudin including the following:

Spinal/Epidural Hematoma. In patients who receive desirudin and need to have spinal or epidural anesthesia at the same time, there is a risk of accumulating blood in the subdural or epidural space in the spine, called a hematoma. This is a serious condition that requires immediate medical attention. Alert your physician if you develop back pain, tingling, numbness (especially in the lower limbs), muscle weakness, or the inability to hold in urine or stool.

Increased risk of bleeding. Desirudin increased the risk of major bleeding in certain patients. Tell your doctor if you have any signs of bleeding or bruising, or if you have or have had any of the following:

• kidney disease
• recent major surgery
• organ biopsy in the last month
• history of hemorrhagic stroke
• bleeding that occurred inside your skull or in your eyes
• recent ischemic stroke
• severe uncontrolled high blood pressure
• an infection of the heart's inner lining or heart valves, called bacterial endocarditis
• a disorder that affects bleeding, such as hemophilia, Von Willebrand disease, sickle cell disease, or liver disease

You should not receive desirudin if you:

• are allergic to desirudin or to any of its ingredients 
• have had an allergic reaction to similar medications such as bivalirudin (Angiomax)
• have an active bleed
• have a disorder that affects your ability to clot blood that cannot be reversed

Medications can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of desirudin, there are no specific foods that you must exclude from your diet when receiving this medication.

Before receiving desirudin, tell your doctor about all of your medical conditions. Especially tell your doctor if you:

• are allergic to desirudin or to any of its ingredients
• have had an allergic reaction to bivalirudin (Angiomax) in the past
• have kidney problems
• have liver problems
• have had recent major surgery
• have had an organ biopsy in the last month
• have a history of hemorrhagic stroke
• have or have had bleeding that occurred inside your skull or in your eyes
• have had a recent ischemic stroke
• have severe uncontrolled high blood pressure
• have an infection of the heart's inner lining or heart valves, called bacterial endocarditis
• have a disorder that affects bleeding, such as hemophilia, Von Willebrand disease, sickle cell disease, or liver disease
• are pregnant or plan to become pregnant
• are breastfeeding or plan to breastfeed

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Desirudin falls into category C. In animal studies, pregnant animals were given this medication and had some babies born with problems. Based on animal data, desirudin may cause harm to your unborn baby. No well-controlled studies have been done in humans. Therefore, this medication may be used if the potential benefits to the mother outweigh the potential risks to the unborn child.

Tell your doctor if you are breastfeeding or plan to breastfeed.

It is not known if desirudin crosses into human milk. Because many medications can cross into human milk and because of the possibility for serious adverse reactions in nursing infants with use of this medication, a choice should be made whether to stop nursing or stop the use of this medication. Your doctor and you will decide if the benefits outweigh the risk of using desirudin.

Desirudin comes in an injectable form to be given directly under the skin (subcutaneous) by a healthcare provider.

Desirudin is typically injected every 12 hours and given up to 5 to 15 minutes prior to surgery. 

You may be taught how to give your medicine at home. Make sure you follow your healthcare provider's instructions exactly if you are injecting desirudin at home.

Your doctor will perform regularly scheduled laboratory tests to check the effects of this medication.

Your doctor will determine your exact dose and how often this medicine will be given. The dose your doctor recommends will be based on your bleeding risk and kidney function.

The recommended dose of Iprivask (desirudin) is 15 mg injected subcutaneously (under the skin) every 12 hours for up to 12 days, with the first dose being given immediately prior to your surgery. This dose may need to be reduced if your kidneys do not work as well as they should.

If you inject too much desirudin, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

If desirudin is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if overdose is suspected, seek emergency medical attention.

• Keep all appointments with your doctor and laboratory.
• If you are injecting desirudin at home, follow your doctor's instructions for mixing and administering this medication. Once mixed, desirudin can be used for up to 24 hours if stored at 25°C (77°F).
• Keep this and all medications out of the reach of children.

Epidural or spinal hematomas, which may result in long-term or permanent paralysis, may occur in patients who are anticoagulated with selective thrombin inhibitors and are undergoing neuraxial anesthesia or spinal puncture. The risk of developing these hematomas is increased with the use of indwelling epidural catheters and concomitant use of drugs affecting hemostasis. Monitor patients frequently for neurological impairment and treat immediately if neurological compromise is noted. Consider risks/benefits before neuraxial intervention in patients anticoagulated or to be anticoagulated for thromboprophylaxis.